Orthopaedic device for correcting deformities of long bones

ABSTRACT

Orthopaedic device ( 10, 110, 210, 310 ) for correcting deformities of a long bone ( 11 ), comprising a bar ( 12 ), extended along an axis (Y-Y) and intended to be placed alongside the bone ( 11 ), at least a first clamp ( 14, 214, 314 ) for a first group of osseous screws ( 16 ) and a second clamp ( 18, 19, 118 ) for a second group of osseous screws ( 20, 22 ), removably mounted on said bar ( 12 ), wherein the first of said clamps ( 14, 214, 314 ) is placed onboard a support base ( 21, 221, 321 ) in turn mounted on said bar ( 12 ), and angularly movable in relation to the support base around a given rotation axis (X-X, X′-X′, Z-Z) by means of a rotary coupling, characterised in that said rotary coupling comprises a male element ( 35; 235, 236, 237, 238, 239; 333, 334 ) associated with the first clamp ( 14, 214, 314 ) and having a surface at least partially cylindrical, and a corresponding female element ( 36; 130; 250, 254, 255; 336, 337 ) associated with the support base ( 21, 221, 321 ) and having a surface at least partially cylindrical constituting a seat for the loose coupling of the male element ( 35; 235, 236, 237, 238, 239; 333, 334 ).

FIELD OF APPLICATION

The present invention refers to an orthopaedic device for correctingdeformities of long bones.

The device is of the type comprising a longitudinal bar extending alonga given axis, able to be positioned outside of the bone, and at least afirst clamp for a first group of osseous screws, and a second clamp fora second group of osseous screws, respectively, in which said clamps areremovably mounted on said longitudinal bar and in which the first ofsaid clamps is placed onboard a support base, in turn mounted on saidlongitudinal bar and it is angularly movable by means of a rotarycoupling around a given rotation axis in relation to the longitudinalbar.

PRIOR ART

In order to correct some deformities of a long bone it is known to usethe technique of subjecting the bone to osteotomy forming two or morepieces, and positioning the two pieces in contact with one another in acorrect position to allow the formation of fibrocartilage callus.

It is also known that, in the case of deformities that consist of acurvature that does not correspond to the natural curvature of the longbone, so-called angular deformities, it is necessary, in addition toplacing the pieces in contact with one another, to adjust the mutualangular position of the two pieces, to reset the correct natural shapeof the bone.

In general, it is known that there is a need to have an orthopaedicdevice, in which it is possible to adjust the mutual angular position ofthe osseous screws to consequently adjust the mutual angular position ofthe pieces based on the shape and curvature of the deformed bone thatmust be corrected.

In order to keep the two pieces in the correct position, it is known touse an orthopaedic device of the aforementioned type outside of thebone, in other words comprising a longitudinal bar positioned externallyon one side of the bone, and on which clamps are slidably mounted thathold respective groups of osseous screws.

The osseous screws are locked in the bone pieces to keep them in contactwith one another.

Even more specifically, there is an orthopaedic device that has beendevised, which is described in patent application VR97A000013 to theApplicant, which comprises angular adjustment means of the two clampswith respect to one another. In particular, one of the two clamps ismounted onboard a support base, which is rotatably mounted, by means ofa rotary coupling, about a substantially longitudinal axis, parallel tothe longitudinal axis of the bar. Even more specifically, the supportbase is mounted on an intermediate body, which is hinged by means of asubstantially transversal axis to a bracket, in turn rotatably mountedabout a longitudinal axis on the longitudinal bar.

Stops screws are foreseen to block the support base about thelongitudinal axes and the bracket in relation to the intermediate bodyand the longitudinal bar, respectively.

An angular displacement of the clamp occurs gradually through a screwhaving an end hinged to the intermediate body, the opposite end providedwith an encased hexagon, and the central portion engaged in a nutplateintegral with the bracket.

The known orthopaedic device, whilst advantageous from various points ofview, and substantially meeting the purpose, does however involvedrawbacks that have not yet been overcome.

The main drawback of the known orthopaedic device is the fact that thefirst angularly moveable clamp can only be arranged at an end of theguiding bar, thus offering a limited possibility of use along the entireextension of the longitudinal bar.

A further drawback of the known orthopaedic device is the fact that theangularly moveable clamp gives the orthopaedic device large overallbulk, to the detriment of its practicality and comfort of use by apatient.

The technical problem forming the basis of the present invention is,therefore, to devise an orthopaedic device having a structure such as toovercome the aforementioned drawbacks in relation to the prior art.

SUMMARY OF THE INVENTION

The aforementioned technical problem is solved by an orthopaedic deviceof the aforementioned type, in which the rotary coupling comprises amale element associated with the first clamp and at least partiallyhaving a cylindrical surface, and which is loosely received in acorresponding female element, which is the seat for the male element,associated with the support base.

Basically, the idea forming the basis of the present invention is tomake a rotary coupling of a cylindrical male element in a female seatdirectly between the clamp and the support base. This configurationallows the overall bulk of the orthopaedic device to be kept low, aswell as making it possible to position the clamp in any position alongthe longitudinal bar.

A further advantage of the invention is also the fact that the rotarycoupling between the at least partially cylindrical surface of the maleelement and the corresponding female seat, where such an element isloosely received, makes it possible to obtain a wide angulardisplacement excursion, and at the same time allowing the clamp and therelative base to be positioned in any position along the longitudinalbar.

Moreover, such a coupling makes it possible to have an orthopaedicdevice that overall is compact and of minimal bulk.

A further advantage of the rotary coupling with cylindrical male elementand relative female seat directly between the first clamp and thesupport base is the possibility of developing a wide assortment ofinterchangeable embodiments, with different rotary couplings, dependingon requirements and the bone deformities to be corrected.

In particular, in a first embodiment, the orthopaedic device isconfigured so that the rotation axis is perpendicular to a plane thatpasses through the longitudinal bar and the osseous screws, to allow anadjustment of the angular position on said plane of the first group ofosseous screws going towards or away from the bone, in relation to theother group of osseous screws.

In such a first embodiment, preferably, the first clamp comprises acylindrical projection with axis coinciding with the rotation axis,which therefore acts as the male element, which is received in acircular hole that is formed in the support base,

Preferably, the support base and the first clamp have a substantiallyrectangular shape with respective long sides and short sides, and thecylindrical projection and the circular hole extend with maximumpossible diameter between the two opposite long sides of the lower jaw,and of the support base, so as to ensure maximum stability in rotation.

In order to guide the angular displacement, in this first embodiment, aguiding slot is foreseen that is shaped like an arc of circle with itscentre on the rotation axis, in which said slot is formed in the firstclamp, and in which a clamping screw is inserted into said slot screwedinto the support base.

Preferably, in order to carry out the angular displacement acompressor/distractor is foreseen comprising a driving screw, and whichis removably connected to the first clamp and the second clamp, and morespecifically the compressor/distractor is connected to the first clampby means of a lever connection element having an arm that extendslaterally in relation to the rotation axis. This lever connectionelement allows the force needed from a user to carry out the angulardisplacement to be reduced.

In this first embodiment, the second clamp comprises two jaws that aremounted directly onboard the longitudinal bar,

Unlike this first embodiment, in a second embodiment the second clampcan translate in relation to the longitudinal bar transversally inrelation to the axis of the longitudinal bar, with a linearreciprocating movement towards and away from the bone. This linearmovement allows a displacement of the bone after the angulardisplacement to be compensated, if necessary.

Preferably, in this second embodiment, the second clamp is mountedonboard a carriage, and it can translate in relation to the carriagewith said linear movement, by means of a driving screw, which rotatesbut does not translate, and which has its shank inserted and heldaxially in a hole of the carriage, and connected through screwing to thesecond clamp.

In a third embodiment of the orthopaedic device according to the presentinvention, the first clamp is both angularly movable in relation to thesupport base with angular displacement about an axis orthogonal to theplane that passes through the osseous screws, and linearly translatablein relation to the support base with linear reciprocating movementparallel to said plane, in a transversal direction, when approaching andmoving away from the bone respectively.

Basically, in this third embodiment, by means of the same first clamp anangular displacement and a linear translation are carried out, to makethe aforementioned compensation of the displacement of the bone due tothe angular displacement, if necessary. Consequently, in this thirdembodiment the second clamp is not of the translatable type, butcomprises, like the first embodiment, two jaws that are mounted directlyonboard the longitudinal bar.

In this third embodiment, in order to make both the angular and lineardisplacements, the orthopaedic device comprises two driving screws,which rotate but do not translate, and that are inserted and heldaxially at the sides of the seat for the male element in correspondingholes of the support base, and screwed into the first clamp at the sidesof the male element, in which said driving screws are actuated togetherin rotation with opposite directions of rotation for the angulardisplacement, and actuated together in rotation with the same directionof rotation to carry out the linear reciprocating movement.

Preferably, in this third embodiment, the first clamp comprises an upperjaw and a lower jaw, closed together by means of two clamping screws, inwhich the lower jaw has a substantially U-shaped profile, and comprises,in a single body, a central block with a substantially rectangularshape, two lateral appendices, which project laterally in an overhangingmanner in relation to the central body and on the bottom of the centralblock, at the four corners thereof, respective flaps having acylindrical profile, in which such flaps constitute a male element forthe angular displacement of the first clamp.

The driving screws are screwed into each of the lateral appendices.

The support base of this third embodiment comprises a substantiallyplate-like body in which a recess is formed having a substantiallyrectangular shape, which forms lateral edges at the sides, and in whicheach lateral edge on the side facing towards the recess has a segmenthaving an inverted L-shaped profile that defines two linear slidingguides, said recess and the two sliding guides defined by it act as aseat for the aforementioned four flaps, thus for the male element.

A corresponding driving screw is inserted at each lateral edge, and itis held there by means of elastic pins received in a gorge of thedriving screw formed between the head and the shank.

In a fourth embodiment, the first clamp is angularly movable in relationto the longitudinal bar about an axis, parallel to the axis of thelongitudinal bar to allow an angular displacement of swinging type ofthe osseous screws. The orthopaedic device in accordance with thisembodiment is adapted to be placed at the side of a long bone having anatural curvature, like for example a femur. The first clamp is placedat such a curvature and is inclined about the rotation axis so as to beable to reach the bone with the osseous screws. The first clamp islocked in the desired angular position by means of a locking screwinserted in the support base, and screwed into the first clamp.

In this fourth embodiment, the first clamp comprises an upper jaw, and alower jaw, closed together by means of locking screws, in which thelower jaw is substantially C-shaped, and comprises a central plate-likebody, having a substantially rectangular shape, and, at the sides, afirst cylindrical body and a second cylindrical body both having an axiscoinciding with the rotation axis, in which said cylindrical bodiesconstitute a male element.

The support base is substantially C-shaped and comprises a substantiallyplate-like rectangular central body on which the plate-like body of thefirst clamp is placed, having, at the relative sides, a first annularbody and a second annular body, both having an axis coinciding with therotation axis, in which cylindrical holes are formed, for looselyreceiving the first and the second cylindrical body. Such annular bodiesthus act as seats for the male element/cylindrical bodies.

The locking screw is preferably inserted in a slot made in the secondannular body of the support base, and screwed into the secondcylindrical body of the first clamp.

Preferably, in this fourth embodiment, the second clamp is not of thetranslating type, but comprises, like in the first embodiment, two jawsthat are mounted directly onboard the longitudinal bar.

Further characteristics and advantages of the orthopaedic deviceaccording to the invention shall become clearer from the followingdescription of some example embodiments given for indicating and notlimiting purposes with reference to the attached drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an axonometric view of an orthopaedic device according to theinvention in accordance with a first embodiment;

FIG. 2 is a view of a clamp of the orthopaedic device of FIG. 1, withparts detached;

FIG. 3 is an axonometric view of the clamp of FIG. 2.

FIG. 4 is a plan view of the clamp of FIG. 3;

FIG. 4 a is a front view of a long bone separated into three pieces withwhich an orthopaedic device according to the invention is associatedwith a T-section bar;

FIG. 5 is a section view along the lines V-V of FIG. 4;

FIG. 6 is an axonometric view from above of a support base of the clampof FIG. 3;

FIG. 7 is an axonometric view from below of a lower jaw of the clamp ofFIG. 2;

FIG. 8 is an axonometric view from above of the jaw of FIG. 7;

FIG. 9 is an axonometric view of another clamp of the orthopaedic deviceof FIG. 1;

FIG. 10 is a plan view of the clamp of FIG. 9;

FIG. 11 is a section view along the line XI-XI of FIG. 10;

FIG. 12 is an axonometric view of an insert of the orthopaedic device ofFIG. 1;

FIG. 13 is an axonometric view of a connection element of theorthopaedic device of FIG. 1;

FIG. 14 is a front view of an orthopaedic device according to theinvention in accordance with a second embodiment;

FIG. 14 a is an axonometric view of an orthopaedic device according tothe invention in accordance with a second embodiment;

FIG. 15 is an axonometric view of a clamp of the orthopaedic device ofFIG. 14;

FIG. 16 is a plan view of the clamp of FIG. 15;

FIG. 17 is a section along the line XVII-XVII of FIG. 16;

FIG. 18 is an axonometric view from below of a carriage of the clamp ofFIG. 14;

FIG. 19 is an axonometric view from below of a lower jaw of the clamp ofFIG. 15;

FIG. 20 is an axonometric view of a detail of the clamp of FIG. 15;

FIG. 21 is an axonometric view with parts detached of the detail of FIG.20;

FIG. 22 is a plan view from below of the clamp of FIG. 15;

FIG. 23 is a view of a screw for the clamp of FIG. 15;

FIG. 24 is a front view of an orthopaedic device according to theinvention in accordance with a third embodiment;

FIG. 24 a is an axonometric view of the orthopaedic device according tothe invention in accordance with the third embodiment;

FIG. 25 is an axonometric view of a clamp of the orthopaedic device ofFIGS. 24 and 24 a;

FIG. 26 is a plan view from above of the clamp of FIG. 25;

FIG. 27 is a section view along the lines XXVII-XVII of FIG. 26;

FIG. 28 is an axonometric view of a detail of the clamp of FIG. 25;

FIG. 29 is an axonometric view with parts detached of the detail of FIG.20;

FIG. 30 is a plan view from below of the clamp of FIG. 25;

FIG. 31 is a section view along the line XXXI-XXXI of FIG. 30;

FIG. 32 is a view from above of the lower jaw of the clamp of FIG. 25;

FIG. 33 is a section view along the line XXXIII-XXXIII of FIG. 32;

FIG. 34 is an axonometric view of a bolt for the clamp of FIG. 25;

FIG. 35 is an axonometric view of an orthopaedic device according to theinvention in accordance with a fourth embodiment;

FIG. 36 is an axonometric view of the orthopaedic device of FIG. 35 in adifferent operating condition;

FIG. 36 a is a side view of the device of FIG. 35;

FIG. 37 is an axonometric view of a clamp for the device of FIG. 35;

FIG. 38 is a plan view of the clamp of FIG. 37;

FIG. 39 is a section view along the line XXXIX-XXXIX of FIG. 38;

FIG. 40 is an axonometric view of a detail of the clamp of FIG. 37;

FIG. 41 is an axonometric view with parts detached of the detail of FIG.40;

FIG. 42 is a view from above partially in section along the lineXLII-XLII of FIG. 40.

DETAILED DESCRIPTION

With reference to the attached figures, reference numerals 10, 110, 210,310 indicate different embodiments of an orthopaedic device according tothe present invention for correcting deformities of a long bone 11, inthe examples a tibia, or a femur. In particular, as highlighted in therelative figures indicated above, in order to allow the correction ofthe deformity, the bone 11 has been subjected to osteotomy with theformation of two pieces 11 a, 11 b (FIG. 1) or to bifocal osteotomy withthe formation of three pieces 11 a, 11 b, 11 c.

In particular, FIGS. 1 to 13 refer to an orthopaedic device 10 inaccordance with a first embodiment.

Such an orthopaedic device 10 comprises a bar 12, which we shall alsodefine hereafter as longitudinal bar and which is made, for example,with synthesis materials like: Orthtek WF®, pultruded with carbon fibrein epoxy resin, or Peek CA30®. The bar 12 can also be made, for example,from aluminium alloy. Such a bar 12 extends along a given axis Y-Y, andis intended to be placed laterally and substantially parallel to thebone 11. The orthopaedic device according to the invention alsocomprises at least one first clamp 14 for a first group of osseousscrews 16 screwed into a first piece 11 a of the bone and a second clamp18 for a second group of osseous screws 20 screwed into a second piece11 b of the bone. These clamps can also be made from Peek CA30® withsteel, titanium alloy or aluminium alloy inserts.

In the example of FIG. 1, the orthopaedic device 10 also comprises athird clamp 19 for a third group of osseous screws 22 also intended tobe screwed into a third piece 11 c of the bone.

All three clamps 14, 18 and 19 are removably mounted on the longitudinalbar 12.

In particular, the second clamp 18 and the third clamp 19 are the sameas one another, (FIGS. 9, 10, and 11), and each of them comprises anupper jaw 23 and a lower jaw 24 closed together by means of two clampingscrews 25, 26; the clamping screws are preferably made from steel and/ortitanium alloy, although other materials may be equally suitable. Eachof them comprises transversal grooves defining transversal seats 29 forhousing the osseous screws 20, 22.

Elastic rings 33, made from silicon or another material, are foreseenarranged inside suitable gorges in the upper jaw 23 and provided forgive friction to the clamping screws 25, 26.

The lower jaw 24 is substantially a fixed jaw if considered in relationto the upper jaw 23 that is removably guided towards and away from sucha lower jaw 24. Of course, the lower jaw 24 should not be considered tobe fixed in relation to the bar 12 on which, conversely, it is slidablyguided like a carriage.

Such a lower jaw 24 has a substantially T-shaped profile with a verticalcore 27 in turn having an inverted T-shaped profile slidably inserted ina matching inverted T-shaped groove 15 of the longitudinal bar 12, andlocked in a given longitudinal position by means of a locking screw 28.

In particular, the latter is inserted from below in a longitudinal holeof the longitudinal bar 12, and screwed into the lower jaw 24 of theclamp 18, 19.

The lower jaw 24 also has lateral fins provided to prevent the two jawsfrom opening when they are subjected to bending moment.

As illustrated in FIGS. 9, 10, 11, all of the screws 25, 26, 28 arescrewed not directly into the body of the clamp, in the example into thebody of the lower jaw 24, but into respective hollow inserts 30, 31, 32preferably made from steel, or else aluminium or titanium alloy,internally threaded, and having a substantially cylindrical shape.

Such inserts 30, 31, 32 are also externally threaded, and in turn lockedin the lower jaw 24 by means of screwing.

One of such inserts 30 is illustrated in FIG. 12.

In particular, the orthopaedic devices 10, 110, 210, 310 of theembodiments described hereafter are provided with further identicalinserts for the locking screws to screw into. For the sake of simplicityand briefness of description, hereafter the description of such insertswill be omitted.

Unlike the two clamps 18 and 19, the first clamp 14 is arranged onboarda support base 21, which is in turn slidably mounted on saidlongitudinal bar 12.

The clamp 14 is also angularly movable in relation to the support base21 by means of rotary coupling of a male element in a female element,and consequently in relation to the longitudinal bar 12 about a givenrotation axis, in the example an axis X-X (FIG. 2) perpendicular to aplane that passes through all of the osseous screws 16, 20, 22, to allowadjustment of the angular position on said plane of the osseous screws16 in relation to the other osseous screws 20, and 22, and thus of thepieces 11 a, 11 b and 11 c of bone connected to them.

In particular, in order to allow the angular displacement, theorthopaedic device 10 comprises a cylindrical projection 35 (FIGS. 5 and7), which constitutes the male element, associated with the clamp 14,and loosely received in a circular hole 36 (FIG. 6), which acts as afemale seat for the male element, which is associated with the supportbase 21.

In particular, in this embodiment, the first clamp 14 comprises an upperjaw 37 (not to be confused with the upper jaw 23 of the second and thirdclamp 18, 19), constituting a removable cover of the clamp 14, and alower jaw 38 (not to be confused with the lower jaw indicated with 24)constituting the fixed base of the clamp 14, and both of the jaws 37 and38 are substantially rectangular in shape.

In particular, the lower jaw 38 is larger in size than the upper jaw 37,with short sides 38 a, 38 b, and long sides 38 c, 38 d, and itcomprises, at a short side 38 b, a lateral extension 51 having a curvedprofile.

Even more specifically, the lower jaw 38 comprises the aforementionedcylindrical projection 35. Such a cylindrical projection 35 projectsfrom a side of the lower jaw 38 opposite to the one facing towards theupper jaw 37.

Like for the clamps 18 and 19, the first clamp 14 is also provided withtransversal seats 39 to receive the groups of screws 16, and with twolocking screws 40, 41 (FIG. 5, not to be confused with the clampingscrews 25, 26 of the other clamps 18 and 19) to close together the upperjaw 37 and the lower jaw 38.

The support base 21 (FIG. 6) comprises a plate-like body having asubstantially rectangular shape with curved short sides 21 a, 21 b andstraight long sides 21 c, 21 d, and a substantially T-shaped transversalprofile with an upper wing 42 constituting a support for the clamp 14and lower vertical core 43, having the same shape as the vertical core27 of the clamps 18 and 19, and thus also having an inverted T-shapedprofile, which is slidingly inserted in the longitudinal groove 15 ofthe longitudinal bar 12.

As stated above, in the support base 21 the through hole 36 is made,constituting the aforementioned seat for the male element, in which theaforementioned cylindrical projection 35 is loosely received.

It should also be observed that the cylindrical projection 35 and thecircular hole 36 occupy a substantial part, and in particular theyextend with maximum possible diameter between the two opposite longsides 38 c, 38 d, 21 c, 21 d of the lower jaw 38, and of the supportbase 21 respectively, in the example with a diameter of 36 mm.

With such a configuration, the first clamp 14 is angularly movable aboutthe axis X-X, by means of rotation of the cylindrical projection 35 inthe corresponding circular hole 36 of the support base 21.

In order to guide the angular displacement of the clamp 14 about theaxis X-X, the orthopaedic device 10 comprises a guiding slot 50 havingan arc of circle shape with centre on the axis X-X, made on the lateralextension 51 of the lower jaw 38. The arched extension of the guidingslot 50 is sufficiently large, in the example the slot subtends an angleto the centre of about 50°, in particular an angular displacement up to25° going towards the bone 11, and an angular displacement up to −25°going away from the bone 11.

In order to block the clamp 14 in whatever angular position in relationto the support base 21, a clamping screw 52 is foreseen inserted fromabove into the guiding slot 50, and screwed into an internally threadedinsert inserted into the support base 21.

As can be observed from the drawings, and in accordance with anotheraspect of the orthopaedic device 10, the lower jaw 38 of the clamp 14 isalso fixed directly to the longitudinal bar 12.

Basically, the clamp 14 is also connected to the longitudinal bar 12. Inparticular, the lower jaw 38 of the clamp 14 comprises a couplingelement 53 projecting coaxially from the cylindrical projection 35 of asmaller size in relation to the projection 35, and having asubstantially T-shaped profile. In practice, such a coupling element 53is inserted laterally by sliding in the T-shaped groove 15 of thelongitudinal bar 12. Thanks to the T-shaped countershaping, the couplingelement 53 constrains the first clamp 14 in the groove 15 of thelongitudinal bar 12, and the constrainment can only be removed bywithdrawing from the groove 15 itself.

Even more specifically, the coupling element 53 has a cylinder shape atan end segment 49, to promote the angular displacement about the axisX-X in the groove 15.

In order to stably lock the clamp 14 in a predetermined axial positionon the longitudinal bar 12, a clamping screw 55 is foreseen, which isinserted into the aforementioned longitudinal through hole 13 of thelongitudinal bar 12 and into the circular hole 36 of the support base21, and is screwed into a hole 56 equipped with a cylindrical insert 57formed in the coupling element 53. In order to lock the angle betweensupport base 21 of the clamp 14 and longitudinal bar 12 it is thusnecessary to clamp the screw identified with numeral 52.

In order to carry out the angular displacement of the osseous screws 16carried by the first clamp 14 in relation to the support base 21, theorthopaedic device 10 comprises a compressor/distractor 58 (FIG. 1) thatcan be removably coupled between the first clamp 14 and the second clamp18.

The compressor/distractor 58 comprises a driving screw 54 having athreaded shank 61 and, at both ends, a first portion off head 59, facingtowards the first clamp 14, and a second portion of head 60, facingtowards the second clamp 18, both provided with an encased hexagon. Byusing a tool on such encased hexagons, it is possible to manoeuvre thescrew 54 in relation to a first internally threaded sleeve 62 in whichit is engaged.

In particular, the threaded shank 61 of the screw 54 is connected to thefirst clamp 14 through a connection element 65 that can be made fromsteel, aluminium alloy or plastic material like Nylon® and silicon,illustrated in FIG. 13, whereas it is connected to the second clamp 18through the first sleeve 62 provided with internal threading, in whichthe shank 61 is screwed, in which such a sleeve 62 is provided with anengagement pin inserted into a matching hole 64 formed on the upper jaw23 of the second clamp 18.

In particular, the connection element 65 comprises a substantially flatplate-like body 66 provided on the lower side with four engagement pins67 which are pressure-inserted in corresponding engaging holes 68 formedon the upper and lower jaws 37, 38 of the clamp 14, and an arm 69provided at the.

free end with at least one eye 70 to which the threaded shank 61 of thescrew 54 is loosely connected. In particular, the eye 70 can be axiallyheld between the first head 59 of the screw 54 and an internallythreaded ring screwed onto the shank 61 of the screw.

In order to obtain the correction with bone transportation by means ofthe orthopaedic device 10, the following is carried out.

After having subjected the bone to two osteotomies, the first two piecesof bone are kept in contact with one another in a correct mutualposition by means of the orthopaedic device 10, whereas between thesecond and the third piece there is a space. In particular, initially,the second clamp 18, and the third clamp 19 are slidingly inserted inthe groove of the longitudinal bar 12 and fixed there in a predeterminedposition by means of the clamping screw 28. Once the callus has beengenerated, by means of the compressor/distractor 58 the clamp 18 ispulled to make the contact between second 11 b and third 11 c piece. Theclamp 14 is slidingly inserted in the groove of the longitudinal bar 12together with the support base 21. In particular, the cylindricalprojection 35 of the lower jaw of the clamp 14 is inserted in thecircular hole 36 of the support base 21, and the coupling element 53 isinserted together with the vertical core 43 of the support base 21 inthe groove of the longitudinal bar 12.

The clamp 14 is locked to the support base 21 by means of the screw 52,and together with the support base 21 locked to the longitudinal bar 12through the screw 55.

Between the lower jaws 24, 38 and upper jaws 23, 37 of all three clamps14, 18, 19 are inserted, and held there through the osseous screws 16,20, 22 which are screwed into the pieces.

The mutual position of the first clamp 14, of the second clamp 18, andof the third clamp 19 on the longitudinal bar is selected so as to bringtogether the two pieces until they are in contact and to allow theformation of fibrocartilage callus.

Thereafter, to adjust the angular position of the two pieces by a givenangle, the compressor/distractor 58 is mounted by means of insertion ofthe engaging pins 67 of the flat button 66, and of the engaging pin ofthe sleeve 62 on the second clamp 18.

The clamping screws 52 and 55 are initially loosened to allow theangular displacement of the clamp 14.

Consequently, by screwing the screw 54 of the compressor 58 in a certaindirection of rotation at the first end 59, or at the second end 60, anangular displacement around the axis X-X of the clamp 14 is obtained inrelation to the support base 21 towards or away from the bone,respectively. In particular, by screwing the compressor 58 to the firstend 59 in one direction of rotation, a positive angular displacement byup to +25° of the clamp 14 is obtained, whereas by screwing at thesecond end 60 a negative angular displacement by up to −25° of the clamp14 is obtained.

Once a correct angular position is reached, the first clamp 14 is lockedto the longitudinal bar 12 by means of definitive clamping of the screw55 and to the support base 21 by means of definitive clamping of thescrew 52.

A first advantage of the orthopaedic device in accordance with thisembodiment is the fact that, thanks to the coupling of the cylindricalsurface of the clamp in the circular hole of the support base, it ispossible to obtain an adjustment of the angular position with arelatively small overall bulk of the clamp.

Moreover, the rotary coupling of the cylindrical surface in the circularhole allows a wide excursion of angular displacement to be obtained, upto 50°.

A further advantage is given by the large diameter of the cylindricalprojection and of the circular hole. Indeed, thanks to such aconfiguration there is a large contact surface between the male elementand the corresponding seat, which ensures high stability of the deviceduring rotation.

A further advantageous aspect is that the angular displacement of theclamp in relation to the support base can be obtained without the needto remove the clamping between the two jaws of the clamp. Basically, theosseous screws can be held between the two jaws during the angulardisplacement, thus giving the benefit of unusual simplicity of use ofthe device by a user.

A further advantage is offered by the stable connection between thecoupling element of the clamp 14 and the longitudinal bar 12. Indeed,there is the advantage that when the clamping screws 55 and 52 areloosened to allow the angular displacement, or else when there is anaccidental loosening or loss of the clamping screw 55, thanks to thestable connection of the coupling element 53 there is not the risk ofthe clamp 14 accidentally coming out or being lost.

A further advantage is offered by the lateral arm of the connectionelement. Such an arm allows the compressor to be arranged on a planethat is displaced in relation to the rotation axis, thus reducing theforce necessary to obtain the angular displacement of the clamp whilethe adjustment screw is being screwed in.

Advantageously, the rotation system, guided by a cylindrical guide thatis large in size thus giving precision in rotation and a distribution ofthe stresses over a large area reducing the risk of seizing.

Moreover, the angular correction force is applied through a connectionin four symmetrical points in relation to the centre of rotation,generating a correct distribution of the load. The force is also appliedonto a high lever arm reducing the force applied for the same resistingmoment.

Moreover, in some cases of bone deformities a simple angulardisplacement is sufficient like in this embodiment, without compensationwith linear displacement, like in the following two embodiments. Inparticular, for small angular corrections it is not usually necessary tohave correction with translation, which makes the system simpler andmore cost-effective, since an angular correction can be made on thetangent where for small angle variations the translation is small (asillustrated in FIG. 14).

With reference to FIGS. 14 to 23, an orthopaedic device 110 inaccordance with a further embodiment is illustrated.

In such figures, components that are the same and ones that that, havethe same function already described keep the same reference numerals.Such shared components are not therefore described again in detail.

The orthopaedic device 110 comprises, mounted on a longitudinal bar 12provided with an inverted T-shaped groove 15, and with a longitudinalhole 13, a first clamp 14 mounted onboard a support base 21, in whichthe longitudinal bar 12, the first clamp 14 and the support base 21 arethe same as those described earlier in relation to the first embodiment.The clamp 14 supports a first group of screws 16 fixed to a first pieceof bone.

The orthopaedic device 110 also comprises a second clamp 118 for asecond group of osseous screws 20, housed in corresponding seats 129 ofthe clamp 118.

The two clamps 14, 118 are connected together by means of thecompressor/distractor 58, which is described in relation to the firstembodiment.

This second clamp 118, unlike the second clamp 18 of the previousembodiment, can translate in relation to the longitudinal bar 12,transversally in relation to the axis Y-Y, with a reciprocating movementwhen approaching and moving away from the bone 11.

In particular, the clamp 118 is mounted onboard a carriage 121, and isable to translate in relation to the carriage 121 with saidreciprocating movement. Such movement is obtained through a drivingscrew 152, which rotates but does not translate, and in particular hasthe shank 152 b inserted and held axially in a hole of the carriage 121,and connected through screwing to the clamp 118, as shall be describedmore clearly hereafter,

In particular, the second clamp 118 comprises a lower jaw 124 and anupper jaw 123, having a substantially rectangular shape, closed togetherby means of clamping screws 125 and 126.

Even more specifically, the lower jaw 124 of the second clamp 118 has,at the sides, respective lateral extensions 127, 128 in whichtransversal holes 132, 133 are made, which form shoulders 127 a, 128 a.

The lower jaw 124 also comprises an appendix 131 projecting towards thecarriage 121. In such an appendix 131, a hole 135 is formed providedwith a relative internally threaded insert 30, the same as thosedescribed earlier with reference to FIG. 12, where the driving screw 152is screwed in.

There is also a groove 134 aligned with the hole 135 to accommodate theshank 152 b of the driving screw 152.

The second clamp 118 is completed by four holes 137 formed passingbetween the upper jaw 123 and the lower jaw 124, and which are intendedto receive the engaging pins 63 of the compressor/distractor 58.

The carriage 121 is substantially in the form of a rectangularplate-like body with short sides 121 a, 121 b and long sides 121 c, 121d and a substantially T-shaped transversal profile, with vertical core142, which, like the support base 21, in turn has an inverted T-shapedprofile to be slidingly inserted in the groove 15 of the longitudinalbar 12.

The body of the carriage 121 has a substantially rectangular recess 130formed in it that extends from an edge of the long side 121 e up toclose to the opposite side 121 d, and forms a sidewall 145 on the longside 121 d, and two opposite flanks 146, 147 on the short sides 121 a,121 b. The aforementioned sidewall 145 carries grooves 150, which arealigned with the seats 129 of the clamp 118. On the side opposite thesidewall 145, at the flanks 146, 147, the carriage 121 also has two endstop walls 148, 149.

At the centre of the sidewall 145 an internally smooth hole 151 isformed, in which the shank 152 b of the driving screw 152 is inserted.Such a hole 151 is aligned with a groove 153 formed at the centre of therecess 130, which is aligned with the groove 134 of the lower jaw 124 toreceive the shank 152 b of the driving screw 152. The carriage 121 alsocomprises a window 154 having a substantially rectangular shape withrounded corners, in which the aforementioned appendix 131 is receivedprojecting from the bottom of the lower jaw 124 of the clamp 118. Thearrangement of the appendix 131 in the window 154, in association withthe driving screw 152 is illustrated in FIG. 22.

At the sides of the window 154 there are oval hollows 155 to receive theends of the clamping screws 125, 126.

The carriage 121 is completed by a locking screw 156 which is insertedin a lateral hole 157 and clamps the body of the carriage 121 to thelongitudinal bar 12.

In order to guide the reciprocating movement of the clamp 118, theorthopaedic device comprises two guide pins 159, having a cylindricalshape, which are inserted in the through holes 132, 133 made along thelateral extensions 127, 128 of the lower jaw 124. The two guide pins 159have ends received in four corresponding holes 160 formed at the walls148, 149 and on the opposite sidewall 145 of the carriage 121.

The driving screw 152 is illustrated in detail in FIG. 23, and comprisesa head 152 a, the aforementioned shank 152 b, and a undercut 152 cformed between the head 152 a and the shank 152 b.

The screw is inserted into the hole of the carriage 121, and into thehole of the appendix until the head abuts against the sidewall 145, sothat the gorge is housed in the hole of the edge.

In order to hold the driving screw 152 in axial position, and to allowit to rotate but not translate, the orthopaedic device 110 compriseselastic or full stop pins 161 which are inserted into the sidewall 145of the carriage 121 from below, in other words from the side of thecarriage 121 facing towards the longitudinal bar 12, at the sides of thedriving screw 152, and received in the undercut 152 c of the screw 152.

Further elastic or full pins 163, 164 (FIG. 22) are received in thesidewall 145 to lock the guide pins 159.

The orthopaedic device 110 described up to now is used in the followingway.

Initially the compressor 58 is fixed on one side by means of theengaging pins 67 of the connection element 65 to the first clamp 14, asdescribed in reference to the first embodiment, and on the other side bymeans of the engaging pin 63 in one of the four holes 137 of the secondclamp 118.

Initially an angular displacement of the osseous screws 16 is carriedout by means of actuation of the screw 54 of the compressor 58,following the same steps described above in relation to the firstembodiment.

After such an angular displacement, for example by an angle of +α(alpha) about the axis X, the piece of bone 11 a connected to the screws16 is inclined by a segment A towards the longitudinal bar 12 inrelation to the bone 11, as indicated by the oblique broken line of FIG.14.

In order to compensate for this translation of the piece of bone 11, thesecond clamp 118 is actuated, so as to maintain a correct alignment ofthe two pieces.

For this purpose, by means of a suitable tool, the driving screw 152 isactuated in one direction of rotation or in the opposite direction, thisrotation without translation determining a relative movement of thelower jaw 124 in relation to the carriage 121 towards or away from thebone 11, respectively.

The displacement of the lower jaw 124 is limited by the stroke of theappendix 131 in the corresponding window 154, and by the oppositesidewall 145 and walls 148, 149.

The main advantage of the present embodiment is the possibility ofcompensating a given lateral displacement by means of the first clamp14, by means of a corresponding linear translation of the second clamp.

This possibility is particularly useful in the cases of bone deformitiesof the knee joint of the varus-valgus type, in other words in the caseof valgus deviations in which the vertical mechanical axis passesoutside the knee, or in the case of varus deviations in which thevertical mechanical axis passes inside it.

Indeed, precisely in these cases of deformities, a roto-translation ofthe two pieces of bone becomes necessary.

A further advantage is the precision in the adjustment of thetranslation movement, thanks to the use of a driving screw. Indeed, inthe example, for every revolution of the driving screw it is possible toobtain a displacement of 1 mm of the second clamp 118.

Advantageously, the fact that it is possible to separate the angularcorrection and the translation correction with two separate controlsmakes it simple and intuitive for the surgeon to use these clamps.

With reference to FIGS. 24 to 34 an orthopaedic device 210 in accordancewith a third embodiment is now illustrated.

In such figures, components that are the same and those that have thesame function already described keep the same reference numerals. Suchshared components are therefore not described again in detail.

The orthopaedic device 210 comprises a first clamp 214 for a first groupof screws 16 and a second clamp 18 for a second group of screws 20,removably mounted on the longitudinal bar 12.

The second clamp 18 and the longitudinal bar 12 are the same as thosedescribed earlier in the first embodiment.

The first clamp 214 is mounted onboard a support base 221, and is bothangularly movable by means of rotary coupling and linearly translatablein relation to the support base 221. The support base 221 is fixed tothe longitudinal bar by means of a locking screw 222.

In other words, in the orthopaedic device 221, by means of a singleclamp 214 it is possible to obtain either an angular displacement aboutan axis X′-X′ orthogonal to the plane that passes through the osseousscrews 16, 20, or a translation with reciprocating movement parallel tosaid plane, in a transversal direction, orthogonal to the axis Y-Y, ofthe longitudinal bar 12 as indicated with A′ in FIG. 24.

In particular, 24. to carry out the angular displacement and the linearmovement the orthopaedic device 210 comprises two driving screws 272,which, as shall be explained more clearly hereafter, rotate but do nottranslate, in which said driving screws 272 are actuated together inrotation with opposite directions of rotation for the angulardisplacement, and are actuated in rotation with the same direction ofrotation to carry out the linear reciprocating movement. Consequently,in this embodiment, the compressor/distractor 58 illustrated for examplein FIG. 1 is not necessary to carry out the angular displacement.

In particular, the first clamp 214 comprises an upper jaw 227 and alower jaw 228, which are closed together by means of two locking screws224, 225. The lower jaw 228 has a substantially U-shaped profile,visible in FIG. 33, and it comprises, in a single body, a central block232 having a substantially rectangular shape, two lateral appendices233, 234, which project laterally in an overhanging manner in relationto the central body 232, and on the bottom of the central block 232, atthe four corners thereof, respective flaps 235, 236, 237, 238 having acylindrical profile.

Such flaps 235, 236, 237, 238 constitute a male element of the rotarycoupling for the angular displacement of the clamp 214.

In the lateral appendices 233, 234 corresponding slots 240, 241 areformed with axis orthogonal to the rotation axis X′-X′, having asubstantially oval profile.

At the slots 240, 241 holes 243,244 are also formed with axis parallelto the rotation axis X′-X′, also having a substantially oval profile. Insuch holes 243, 244 corresponding cylindrical bolts 245 are inserted,one of which is depicted in FIG. 34, having a smooth external surfaceand an internally threaded transversal hole. Each bolt 245 is insertedinto the respective hole 243, 244, and has a threaded hole 246, in whicha threaded pin is inserted, having its centre aligned in relation to thecentre of the slot 240, 241.

Driving screws 272 are screwed into the holes 246 of the cylindricalbolts.

The support base 221 comprises a substantially plate-like body in whicha recess 250 is formed having a substantially rectangular shape, whichforms lateral edges 251, 252 at the sides. In particular, each lateraledge 251, 252 on the side facing towards the recess 250 has a segmenthaving an inverted L-shaped profile that defines two sliding guides 254,255 for the clamp. In particular, the projecting segment of the L-shapedprofile is inserted into a matching linear groove 253 formed on thesides of the central body 232 of the lower jaw 228. The recess 250 andthe two sliding guides 254, 255 defined by it act as a female element,the seat for the male element.

The support base 221 also comprises, at each lateral edge 251, 252, twovertical appendices 260, 261, which project in an overhanging mannertowards the lower jaw 228, and having an internally smooth hole 268, 269centred with the holes 246 of each bolt 245, as illustrated in FIG. 28.

In order to drive the reciprocating movement and the angulardisplacement, the orthopaedic device 210 comprises the aforementionedtwo driving screws 272 each of which is inserted in the hole 268, 269 ofthe vertical appendix 260, 261, and screwed into the hole 246 of theinsert 245.

Each driving screw 272 has substantially the same structure as thedriving screws 152 described in the second embodiment, and thereforecomprises a head, a shank, and a gorge arranged between head and shank.

Also in this embodiment, to axially hold each driving screw 272, toallow it to rotate but not translate, the orthopaedic device 210comprises elastic stop pins 280, 281 which are inserted into thevertical appendices 260, 261 of the support base 221 from the bottom, inother words from the side of the support base 221 facing towards thelongitudinal bar 12, to the sides of each driving screw 272, andreceived in the gorge of the screw, as illustrated in FIG. 31.

The operation of the orthopaedic device 210 is the following.

The first clamp 214 is slidingly housed onboard the support base 221, inparticular in the recess 250, and connected to the support base 221 bymeans of the driving screws 272.

The support base 221 is fixed in a given position on the longitudinalbar 12 in a distanced relationship from the second clamp 18.

In order to carry out an angular displacement the two driving screws 272are actuated together in rotation with opposite directions of rotation.In particular, the rotation in opposite directions of the two drivingscrews 272 causes an angular displacement of the lower jaw 228, andconsequently of the entire clamp 214.

It should be noted that the angular displacement of the lower jaw 228 ofthe clamp 214 in relation to the support base 221 is permitted thanks tothe oval shape of the vertical holes, and of the slots 240, 242 withhorizontal axis, in which the cylindrical bolts 45 are housed connectedto the driving screws 272.

During the angular displacement, the lower jaw 228 rotates upon itselfin the recess, and thanks to the cylindrical profile of the four flaps235, 236, 237, 238 stability in angular displacement is ensured.

Once the angular displacement has been carried out, a translation of thefirst clamp 214 is carried out towards or away from the bone, tocompensate for the linear displacement of the piece of bone followingthe angular displacement.

For this purpose, the two driving screws are screwed in the samedirection of rotation thus causing a linear displacement of the lowerjaw 228, and consequently of the entire clamp 214.

The same piece of bone which has subjected is subjected to linearcompensating displacement.

The main advantage of the present embodiment is the possibility ofcarrying out a stable angular displacement of the clamp in relation tothe support base, and at the same time obtaining a precise translationof the clamp. In practice, in relation to the previous embodiment, inthis third embodiment, a correction in varus-valgus can be obtained witha single clamp,

The linear guides 254, 255 that as stated act as a seat for the maleelement, guide such an element, in the example represented by the fourflaps, both during the angular displacement and during the translationwithout generating instability.

Like in the second embodiment, it is possible, thanks to the drivingscrews, to obtain a micrometric movement of 1 mm per screw turn.

With reference to FIGS. 35 to 42 a fourth embodiment of the orthopaedicdevice 310 according to the invention is illustrated.

In such figures, components that are the same and those that have thesame function already described in the previous embodiments keep thesame reference numerals. Such shared components are therefore notdescribed again in detail.

In particular, the orthopaedic device 310 comprises a first clamp 314for a first group of osseous screws 16, and a second clamp 18 for asecond group of osseous screws 20 removably mounted on a longitudinalbar 12.

The orthopaedic device 310 comprises a third clamp 19 for a third groupof screws 22, also removably mounted on the longitudinal bar 12. Thesecond clamp 18, the third clamp 19, and the longitudinal bar 12 are thesame as those described with reference to the first embodiment.

The first clamp 314 is placed onboard a support base 321, in turnmounted on the longitudinal bar 12.

In particular, the first clamp 314 is angularly movable, by means of arotary coupling, in relation to the longitudinal bar 12 about an axisZ-Z, parallel to the axis Y-Y of the longitudinal bar 12 to allow anangular displacement of swinging type of the screws 16.

In particular, the clamp 314 comprises an upper jaw 327, and a lower jaw328, closed together by means of locking screws 329, 330, and betweenwhich there are transversal seats 331 housing the osseous screws 16.

The upper jaw 327 comprises a plate-like body having a substantiallyrectangular shape. The lower jaw 328, on the other hand, issubstantially C-shaped, and comprises, at the sides, a first cylindricalbody 333 and a second cylindrical body 334 both with axis Z-Z. Suchcylindrical bodies are joined by a central plate-like body 332,corresponding to that of the other jaw, having a substantiallyrectangular shape. The cylindrical bodies 333, 334 constitute a maleelement of the rotary coupling to allow an angular displacement aboutthe aforementioned axis Z-Z. In the second cylindrical body 334 aninternally threaded through hole 345 is formed in which a pair ofinserts 30 are screwed, aligned with one another, of the typeillustrated in FIG. 12, in which a locking screw 346 is screwed. As itis possible to observe from FIG. 42, the presence of two inserts 30allows the locking screw 346 to be inserted from both sides of the clamp314, both right and left.

Even more specifically, as can be observed from the drawings, the entireclamp 314 and the support base 321 are symmetrical in relation to theaxis Z- Z, so as to be able to be inserted indistinctly on the left orright side of the long bone.

The support base 321 is substantially C-shaped, and comprises asubstantially plate-like rectangular central body 335, having, at therelative sides, a first annular body 336 and a second annular body 337,both with axis Z-Z, in which cylindrical holes are formed, for looselyreceiving the aforementioned first and second cylindrical body 333, 334,and which therefore act as female elements, seats for the male element.

The support base 321 is fixed to the longitudinal bar 12 by means of aclamping screw 339 screwed into a corresponding insert 30, at the secondannular body 337.

The second annular body 337 also comprises, on opposite sides, a pair ofslots 340, 341 having an oval shape, elongated in the directionorthogonal to the axis Z-Z, which allows the locking screw 346 to beinclined in a predetermined angular position in relation to the axis Z-Zdepending on the angular position of the clamp 314.

The clamp 314 comprises a disc element 342, placed on the side of thesecond annular body 337 of the support base 321, and fixed by means ofscrews 343, 344 in the second cylindrical body 334, which acts as alateral cover. In particular, as illustrated in FIG. 41, the lower jaw328 is inserted laterally passing through the annular bodies 336, 337,until a radial projection 351 goes into abutment against a shoulder 350formed on the second annular body 337 of the support base 321, and it islaterally held in such a position by means of the disc element 342.

Thereafter, by keeping the locking screw 346 in loose condition, thuspartially unscrewed, the angular position of the clamp 314 is manuallyadjusted in relation to the other clamps 18, 19, carrying out an angularrotation of the clamp 314 about the axis Z-Z. In order to keep the clamp314 in said desired angular position, the locking screw 346 is screwedin completely until the second cylindrical body 334 of the lower jaw isclamped in the second annular body 337 of the support base 321.

The main advantage of the orthopaedic device 310 in accordance with thisembodiment is the fact that it allows an adjustment of the angularposition of the screws associated with the clamp 314 about an axissubstantially parallel to the axis of the longitudinal bar to adapt to anatural curvature of a bone, like in the case of a femur.

Also in this embodiment, the housing of the cylindrical bodies, in otherwords of the male element, in the respective annular bodies, in otherwords in the female element, the seat for the male element, gives highstability in rotation.

Another advantage of the orthopaedic device 310 that is offered by thesymmetrical configuration of the swing clamp is the possibility ofadjusting the position of the swing clamp in the same way both in aright femur and in a left femur.

The special structure of the device according to the invention, in itsvarious embodiments, allows the threaded inserts to be housed and thestresses to be reduced so as to be able to be built even from plasticmaterial.

Of course, a person skilled in the art can bring modifications andvariants to the orthopaedic device described above, in order to satisfycontingent and specific requirements, all of which are covered by thescope of protection of the invention as defined by the following claims.

1. Orthopaedic device (10, 110, 210, 310) for correcting deformities ofa long bone (11), comprising a bar (12), extended along an axis (Y-Y)and intended to be placed alongside the bone (11), at least a firstclamp (14, 214, 314) for a first group of osseous screws (16) and asecond clamp (18, 19, 118) for a second group of osseous screws (20,22), removably mounted on said bar (12), wherein the first of saidclamps (14, 214, 314) is placed onboard a support base (21, 221, 321) inturn mounted on said bar (12), and angularly movable in relation to thesupport base around a given rotation axis (X-X, X′-X′, Z-Z) by means ofa rotary coupling, characterised in that said rotary coupling comprisesa male element (35; 235, 236, 237, 238, 239; 333, 334) associated withthe first clamp (14, 214, 314) and having a surface at least partiallycylindrical, and a corresponding female element (36; 130; 250, 254, 255;336, 337) associated with the support base (21, 221, 321) and having asurface at least partially cylindrical constituting a seat for the loosecoupling of the male element (35; 235, 236, 237, 238, 239; 333, 334). 2.Orthopaedic device according to claim 1, characterised in that the maleelement is a cylindrical projection (35), and that the female element isa circular hole (36) associated with the support base (21) to receivethe cylindrical projection.
 3. Orthopaedic device according to claim 1,characterised in that said first clamp (14) is angularly movable aroundan axis (X-X) perpendicular to a plane that passes through all theosseous screws (16, 20, 21), to allow for an adjustment of the angularposition on said plane of the first group of osseous screws (16) inrelation to the other group of osseous screws (20, 22).
 4. Orthopaedicdevice according to claim 2, characterised in that the first clamp (14)comprises an upper jaw (37), constituting a removable lid of the clamp(14), and a lower jaw (38) constituting a fixed base of the clamp (14),wherein the lower jaw (38) comprises said cylindrical projection (35).5. Orthopaedic device according to claim 4, characterised in that thesupport base (21) comprises a plate-like body with a substantiallyT-shaped transversal profile with upper wing (42) constituting a supportfor the angularly movable clamp (14) and vertical core (43) having inturn an overturned T-shaped shaped profile, which is slidingly insertedinto a longitudinal groove (15) of the longitudinal bar (12). 6.Orthopaedic device according to claim 5, characterised in that saidsupport base (21) and the lower jaw (38) have a substantiallyrectangular shape with respective long sides (38 c, 38 d, 21 c, 21 d)and short sides (38 a, 38 b, 21 a, 21 b), and that the cylindricalprojection (35) and the circular hole (36) extend with a maximumpossible diameter between the two opposite long sides (38 c, 38 d, 21 c,21 d) of the lower jaw (38), and of the support base (21). 7.Orthopaedic device according to claim 6, characterised in that itcomprises a guiding slot (50) having the shape of an arc of circle withthe centre on the rotation axis (X-X), made in the lower jaw (38), whichreceives a clamping screw (52) screwed into the support base (21). 8.Orthopaedic device according to claim 7, characterised in that theguiding slot subtends an angle at the centre of about 50°, in particularan angular displacement up to 25° when approaching the bone 11, and anangular displacement down to −25° when moving away from the bone
 11. 9.Orthopaedic device according to claim 4, characterised in that the lowerjaw (38) of the angularly movable clamp (14) is directly fixed to thelongitudinal bar (12).
 10. Orthopaedic device according to claim 9,characterised in that the lower jaw (38) comprises a coaxial couplingelement (53) projecting from the cylindrical projection (35), of reducedsize in relation to the projection (35), and having a substantiallydovetail-shaped profile, and intended to be laterally inserted forsliding into the longitudinal bar (12).
 11. Device according to claim10, characterised in that the coupling element (53) has a cylindricalshape at an end segment (49), to help the angular displacement aroundthe rotation axis (X-X).
 12. Orthopaedic device according to any one ofthe previous claims, characterised in that it comprises a clamping screw(55), which is inserted into the longitudinal bar 12 and into thecircular hole (36) of the support base (21), and is screwed into a hole(56) in said coupling element (53).
 13. Device according to any one ofthe previous claims, characterised in that it comprises acompressor/distractor (58) comprising a screw (54) and removablyconnected to the first clamp (14) and the second clamp (18) to performthe angular displacement of the osseous screws (16) borne by the firstclamp (14) in relation to the support base (22).
 14. Orthopaedic deviceaccording to claim 13, characterised in that said compressor/distractor(58) is connected to the first clamp (14) by means of a connectionelement (65) having an arm (69) which extends laterally in relation tothe rotation axis (X-X).
 15. Orthopaedic device according to claim 14,characterised in that the connection element (65) comprises said arm(69) and a plate-like body (66), connected to said arm (69), provided onthe lower side with four engaging pins (67) which are inserted bypressure into corresponding engaging holes (68) made on the upper jaw(37) of the clamp (14), wherein said arm (69) is provided at the freeend with an eye to which the threaded shank (61) of the screw (54) isloosely connected.
 16. Orthopaedic device according to any one of theprevious claims, characterised in that the second clamp comprises twojaws, which are mounted directly onboard the longitudinal bar (12). 17.Orthopaedic device according to any one of claims from 1 to 15,characterised in that the second clamp (118) is translatable in relationto the longitudinal bar (12), transversally in relation to the axis(Y′-Y′) of the longitudinal bar (12), with a reciprocating movement whenapproaching and moving away from the bone (11).
 18. Orthopaedic deviceaccording to claim 17, characterised in that the second clamp (118) ismounted onboard a carriage (121), and is translatable in relation to thecarriage (121) with said reciprocating movement, by means of a drivingscrew (152), which has a shank (152 b) inserted into a hole of thecarriage (121), and connected through screwing to the second clamp(118).
 19. Orthopaedic device according to claim 18, characterised inthat the second clamp (118) comprises a lower jaw (124) and an upper jaw(123), having a substantially rectangular shape, closed betweenthemselves by means of clamping screws (125, 126), wherein the lower jaw(124) of the second clamp (118) has, at the sides, respective lateralextensions (127, 128) in which transversal holes (132, 133) are made,which form shoulders (127 a, 128 a), and wherein the lower jaw (124)also comprises an appendix (131) projecting towards the carriage (121),and in which an internally threaded hole (135) is made, where thedriving screw is screwed (152).
 20. Orthopaedic device according toclaim 19, characterised in that the carriage (121) comprises arectangular plate-like body with short sides (121 a, 121 b) and longsides (121 c, 121 d) and a substantially T-shaped transversal profile,with vertical core (142), which has in turn an overturned T-shapedprofile to be slidingly inserted into a groove (15) of the longitudinalbar (12), and wherein a substantially rectangular recess (130) is madein the plate-like body of the carriage (121) which extends from one rimof the long side (121 c) to near the opposed side (121 d), and forms anedge (145) on the long side (121 d), and two opposed sides (146, 147) onthe short sides (121 a, 121 b), wherein the lower jaw (124) of thesecond clamp (118) is housed in said recess (130).
 21. Orthopaedicdevice according to claim 20, characterised in that an internally smoothhole is made (151) at the centre of the edge (145), in which the shank(152 b) of the driving screw (152) is inserted, and wherein the carriage(121) also comprises a window (154) placed at the centre of the recess(130) and having a substantially rectangular shape with rounded edges,in which the above-mentioned appendix (131) projecting from the bottomof the lower jaw (124) of the clamp (118) is received.
 22. Orthopaedicdevice according to claim 21, characterised in that the driving screw(152) comprises a head (152 a), the above-mentioned shank (152 b) and agorge (152 c) made between the head (152 a) and the shank (152 b), andis inserted into the hole of the carriage (121) until the abutment ofthe head (152 a) against the edge (145), so that the gorge (152 c) ishoused in the hole of the edge (145) and that, to retain the drivingscrew (152) in axial position, and allow it to rotate but not translate,elastic stop pins (161) are inserted into the edge (145) of the carriage(121) at the sides of the driving screw (152), and received in the gorge(152 c) of the screw (152).
 23. Orthopaedic device according to claim 1,characterised in that the first clamp (214) is either angularly movablein relation to the support base (221) with angular displacement aroundan axis (X′-X′) orthogonal to the plane that passes through the osseousscrews (16, 20), or linearly translatable in relation to the supportbase (221) with reciprocating movement parallel to said plane, in atransversal direction, orthogonal to the axis (Y-Y), of the longitudinalbar (12) when approaching and moving away from the bone (11). 24.Orthopaedic device according to claim 23, characterised in that itcomprises two driving screws (272) inserted at the sides of the seat forthe male element (250, 254, 255) into corresponding holes (260, 261) ofthe support base (221), and screwed into the first clamp (214) at thesides of the male element (235, 236, 237, 238), wherein said drivingscrews (272) are rotatingly operated together with opposite rotationdirections for the angular displacement, and are rotatingly operatedwith the same rotation direction to perform the linear reciprocatingmovement
 25. Orthopaedic device according to claim 24, characterised inthat the first clamp (214) comprises an upper jaw (227) and a lower jaw(228), closed between themselves by means of two clamping screws (224,225), wherein the lower jaw (228) has a substantially U-shaped profile,and comprises, in a single body, a central block (232) having asubstantially rectangular shape, two lateral appendices (233, 234),which project laterally in an overhanging manner in relation to thecentral body (232), and on the bottom of the central block (232), at thefour corners of the latter, respective flaps (235, 236, 237, 238) havinga cylindrical profile, wherein such flaps (235, 236, 237, 238)constitute the male element for the angular displacement of the firstclamp (214).
 26. Orthopaedic device according to claim 25, characterisedin that in said lateral appendices (233, 234) corresponding slots aremade (240, 241) with axis orthogonal to that of rotation (X′-X′), havinga substantially oval profile, and that, at the slots (240, 241), holes(243, 244) are also made with axis parallel to the rotation axis(X′-X′), these too having a substantially oval profile, whereincorresponding cylindrical bolts (245) are inserted by pressure into suchholes (243, 244), having a smooth external surface and an internallythreaded transversal hole having the centre aligned with the respectivecentre of the slot (240, 241), wherein the driving screws (272) arescrewed in said holes (246) of the bolts,
 27. Driving device accordingto claim 26, characterised in that the support base (221) comprises asubstantially plate-like body in which a recess (250) is made, having asubstantially rectangular shape, which forms lateral edges (251, 252) atthe sides, and that each lateral edge (251, 252) on the side orientedtowards the recess (250) has a segment having an overturned L-shapedprofile which defines two linear sliding guides (254, 255), said recess(250) and the two sliding guides (254, 255) defined by it serving as afemale element, seat for the male element.
 28. Orthopaedic deviceaccording to claim 27, characterised in that the support base (221) alsocomprises, at each lateral edge (251, 252), two appendices (260, 261),which project in an overhanging manner towards the lower jaw (228) ofthe first clamp, and having an internally smooth hole (268, 269) centredwith the holes (246) of each bolt (245) to each receive thecorresponding driving screw (272).
 29. Orthopaedic device according toclaim 28, characterised in that each driving screw (272) comprises ahead, a shank, and a gorge made between the head and the shank, and isinserted into the hole of a corresponding appendix of the support baseuntil the abutment of the head, so that the gorge is housed in the holeof the appendix, and that, to retain the driving screw in axialposition, and allow it to rotate but not translate, elastic stop pins(280, 281) are inserted into the vertical appendices (260, 261) of thesupport base (221) at the sides of each driving screw (272), andreceived in the gorge of the screw.
 30. Orthopaedic device according toclaim 1 characterised in that the first clamp (314) is angularly movablein relation to the longitudinal bar (12) around an axis (Z-Z), parallelto the axis (Y-Y) of the longitudinal bar (12) to allow for an angulardisplacement of swinging type of the osseous screws (16), 31.Orthopaedic device according to claim 30, characterised in that thefirst clamp (314) comprises an upper jaw (327), and a lower jaw (328),closed between themselves by means of locking screws (329, 330), whereinthe lower jaw (328) has a substantial C-shape, and comprises a centralplate-like body (332), having a substantially rectangular shape, and atthe sides, a first cylindrical body (333) and a second cylindrical body(334), both of axis (Z-Z), coinciding with the rotation axis, whereinsaid cylindrical bodies (333, 334) constitute a male element to allowfor an angular displacement around the above-mentioned axis (Z). 32.Orthopaedic device according to claim 31, characterised in that aninternally threaded through hole (345), into which a locking screw (346)is screwed, is made in the second cylindrical body (334). 33.Orthopaedic device according to claim 32, characterised in that thesupport base (321) has a substantial C-shape, and comprises asubstantially plate-like rectangular central body (335) on which theplate-like body (332) of the first clamp (314) is placed, and having, atthe corresponding sides, a first annular body (336) and a second annularbody (337), both of axis coinciding with the rotation axis (Z-Z), inwhich cylindrical holes are made, for the loose reception of the firstand second cylindrical bodies (333, 334), so as to serve as a femaleelement, seat for the male element.
 34. Orthopaedic device according toclaim 33, characterised in that the second annular body (337) comprises,on opposite sides, a pair of slots (340, 341) having an oval shape inwhich the locking screw (346) is housed, said slot being elongated in adirection orthogonal to the rotation axis (Z-Z), which allows for aninclination of the locking screw (346) in a preset angular position inrelation to the axis (Z-Z) depending on the angular position of theclamp (314).
 35. Orthopaedic device according to claim 34, characterisedin that the first clamp (314) comprises a disc element (342), placed onthe free side of the second annular body (337) of the support base(321), and fixed by means of screws (343, 344) to the second cylindricalbody (334), which serves as a side cover.